Reasons For Pre-Exposure Prophylaxis Discontinuation Among Men Who Have Sex With Men and Transgender Women At Risk for HIV Infection

Background: HIV is transmitted by body fluids. As of 2017, 36.9 million people worldwide live with HIV. In Thailand, about 440,000 people live with HIV, accounting for 9% of the region’s total population of people living with HIV. Thus Thailand has high HIV prevalence in the Asia Pacific region. Prevention strategies are effective in the transmission and acquisition of HIV. Oral pre-exposure prophylaxis (PrEP) is the most effective HIV prevention option with an HIV prevention efficacy of 92% when the virus is detected in the blood. When taken in tandem with condoms and adherence to the PrEP regimen, these preventive measures can result in 100% efficacy of preventing the transmission and acquisition of HIV, and sexually transmitted infections (STI). PrEP is offered to anyone who is at risk of HIV infection such as men who have sex with men (MSM), sex workers, transgender women (TGW), and people who inject drugs (PWID). More than half of new HIV infections occur in MSM and TGW in Thailand. In order to provide prevention assistance for these key populations, PrEP is offered to them free of charge through the Princess PrEP Program.

Objective: To assess reasons behind discontinuation of PrEP offered free of charge among high-risk populations in Bangkok, Thailand.

Materials and Methods: The reasons for discontinuation was explored using a behavior and risk factor survey to better explore why clients discontinue PrEP. Surveys were sent through online messenger, email, and mail, in which 120 surveys were returned.

Results: 92 out of 120 respondents (70%) discontinued PrEP. Among TGW and MSM, the main reason for discontinuing PrEP was the fact that clients felt that they were no longer at risk. Over 30% respondents reported that they were no longer at risk, and 60% said they would restart PrEP when their risk increases. Self reported risk behaviors were that of the clients who reported to not be at risk, 43% may not be using condoms, and more than 50% did not return for testing.

Conclusion: At-risk clients misperceive their HIV risk. These results will help in further promoting PrEP services to provide knowledge and discussions for clients about HIV risks, and how to lower risk.